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Ear Set-Back Surgery

Ears come in all shapes and sizes. At times patients may have one ear more prominent and a different shape compared to the other ear. A prominent ear can be caused by an unduly deep conchal bowl. At other times an ear may not have developed an appropriate fold in the anti-helical rim. In such cases these ears are affectionately called ‘bat ears’. Some patients may find that their ear lobes are too large or are sitting in an oblique fashion. The causes may be from previous trauma or simply hereditary. Either way at times patients will go to great lengths to try and camouflage their ears with either hair styling, or wearing hats or scarves. Indeed some patients develop a strict ritual so that the ears will not become a focus of others’ conversation. At times patients will avoid certain activities such as swimming or running because their ears cannot be covered appropriately.

At your initial consultation with Dr Flood a detailed assessment of both ears including symmetry, shape and size is made. A diagnosis is made why the ear is a certain shape and size assessing both the upper, middle and lower poles of each ear. Photographs are taken for documentation.
Otoplasty or ear pinning is performed as a day surgery procedure under general anaesthetic. At times the procedure can be performed under local anaesthetic depending on the technique that is used to set back the ear. The procedure takes one and a half hours. The incisions are made behind the ear so that all scars are hidden.

The procedure of otoplasty or ear pinning involves lifting the skin of the ear off the underlying ear cartilage. The ear cartilage is then re-shaped or at times excessive cartilage is removed. Once the ear cartilage has been re-shaped into a more pleasing position and shape dissolvable sutures are then used to support the cartilage in this new position. These dissolvable sutures usually dissolve over a period of six months and do not need to be removed. This is especially important for children to be aware of as it avoids suture removal anxiety. At the end of the procedure the ear skin is then re-draped over this new cartilage framework and any excessive skin can then be removed. The scar line is hidden behind the ear.

A dressing is then placed to support the ear in its new shape and to avoid blood or fluid accumulating between the skin and the newly shaped cartilage. The dressing usually stays in place for seven days. Patients are usually allowed to go home on the day of surgery. Pain relief is in the form of tablets and no narcotics are required. Most people find that their ear feels somewhat uncomfortable for the first 24 hours. Antibiotics are prescribed to reduce the risk of infection.

Once the head bandage is removed after seven days patients are allowed to shower and wash their hair and behind their ears. Patients are then instructed to wear a terry toweling tennis headband to support their ears of a night-time for a further five weeks. This avoids inadvertent folding of the ear during sleep. Contact sports are avoided during this time as well. It is expected after the head bandage is removed that some bruising will still be present for a further few days. Swelling at times may take a further few weeks to subside. Often the ear skin will feel somewhat numb and tingling will start to return to the ear skin over the next few weeks.

Patients return at the six week mark post-operatively for a further scar check. At that time they are educated regarding scar massage to the ear. Sensation by this stage has started to return and is usually complete by three to four months post-operatively.

Complications of the procedure involve infection, bleeding, excessive pain, skin loss, asymmetry, unsatisfactory position, poor scarring and appearance. Although such complications are rare they can occur. As no two ears are identical it is important for patients to be aware that at times there may be minor differences between both ears following their surgery. This is usually not noticeable to other people. However patients naturally after an operation will be very particular and tend to look in the mirror for any slight imperfections over the first eight weeks post-operatively. Over time when patients stop ‘looking in the mirror’ they usually find they are very pleased with the results. Their rituals of hair dressing and activity avoidance usually cease. The procedure in the vast majority of patients helps to restore their self-confidence.

Important considerations prior to surgery include ceasing smoking for at least two weeks pre-operatively as well as two weeks post-operatively and ceasing medication that may thin the blood for at least two weeks pre-operatively as well as two weeks post-operatively. This includes herbal supplements.